Healthcare Provider Details

I. General information

NPI: 1295793289
Provider Name (Legal Business Name): DENTAL ASSOCIATES OF EASLEY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S PENDLETON ST
EASLEY SC
29640-3051
US

IV. Provider business mailing address

415 S PENDLETON ST
EASLEY SC
29640-3051
US

V. Phone/Fax

Practice location:
  • Phone: 864-859-0111
  • Fax: 864-859-0112
Mailing address:
  • Phone: 864-859-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DARLA LUCAS
Title or Position: REGIONAL DIRECTOR OF OPERATIONS
Credential:
Phone: 864-523-5771